MIX 3 QBANK Flashcards
(131 cards)
1
Q
indications for melanoma sentinel lymph node biopsy
A
thickness greater than 1 mm
2
Q
treatment of thymoma
A
all should be approached with aggressive surgical management regardless of symptoms
Including invasive thymomas with radical resection
Postoperative radiation can improve local recurrence if pericapsular invasion
3
Q
perioperative management of myasthenia gravis patient for thymoma
A
stop Anticholinesterase inhibitor 72 hours before surgery - decrease his pulmonary secretions
4
Q
Hodgkin’s lymphoma staging and associated cells
A
Reed-Sternberg
Stage I-single lymph node
Stage II-2 or more sites on the same side of diaphragm
Stage III-both sides the diaphragm, spleen is counted as involved lymph node tissue
Stage IV-disseminated and involved lymphatic organs
Constitutional symptoms designate B:
fever, weight loss, night sweats, pruritus
5
Q
how are triglycerides processed
A
short and medium chain fatty acids
Tubes or by intestinal epithelium directly
6
Q
how are longchain fatty foods processed
A
requires lipase
Transported in mixed micelles to enterocytes - then recent incised into triglycerides in the form of chylomicrons and the created in the intestinal lymph chyle
7
Q
renal cell carcinoma risk factor, presentation, lap markers, site of metastases
A
major risk of smoking
Associated with paraneoplastic syndrome including: Erythrocytosis parathyroid like hormone: PTHrp ACTH Renton
LUNG most common site of metastases
Isolated metastases may be resected at time of operation
8
Q
Treatment for renal cell carcinoma
A
radical nephrectomy
ONLY partial nephrectomy patient to require dialysis as a result of removing kidney
9
Q
Brown-Séquard syndrome
presentation symptoms
Mechanism of injury
prognosis
A
injury to half the spinal cord
Ipsilateral loss of motor ( careful, this is opposite from brain)
Contralateral lots of pain and temperature
cause contralateral symptoms below level of injury:
Spinal thalamic
Posterior column
mechanisms of injury:
Disc herniation
Vasculitis and radiation exposure
Penetrating trauma
Prognosis: Variable
10
Q
blood supply of cervical esophagus
A
inferior thyroid artery (branch of thyrocervical trunk from subclavian artery)
11
Q
laboratory values associated with hemophilia
A
elevated APTT
normal PT and bleeding time
12
Q
laboratory values associated with von Willebrand’s
A
increased bleeding time from dysfunctional platelets
13
Q
laboratory values associated with vitamin K deficiency
A
factors 2, 7, 9, 10 protein C and S.
increased PT AND aPTT
14
Q
trauma patient with hemophilia A which should be given
A
if no factor concentrate preparations care of
CRYOPRECIPITATE ( more concentrated in FFP)
15
Q
fuel source for colon
A
Short chain fatty acids
butyrate
propionate
acetate
Large bowel is short
16
Q
fule source for small bowel
A
glutamine
17
Q
diagnosing Zollinger-Ellison syndrome
A
gastrinoma fasting serum gastrin will greater than 100 AND and a basal acid output greater than 15 consistent with dx
Secretin stimulation test increased gastrin greater than 200 (110-120) confirms
Imaging:
Somatostatin scintigraphy greater sensitivity than all conventional studies combined
EUS high-sensitivity for detection of pancreatic gastrinoma
not good for duodenal gastrinom
If cannot find gastrinoma:
-hepatic vein sampling with calcium stimulation
18
Q
left congenital cyanotic heart defect
A
tetralogy of flow Transposition of great vessels Pulmonary atresia with intact VSD Pulmonary atresia with VSD Valvular pulmonic stenosis
19
Q
management of wrist drop after mid humerus shaft fracture
A
presence of radial nerve palsy does not indicate surgical exploration in all cases
possible indications include:
Open fracture
Stab injury
20
Q
most common cause mortality of cardiac transplant after one year
A
atherosclerosis Causes include: Natural disease process Diabetes Hyperlipidemia Smoking Chronic immunosuppression Opportunity to infection
21
Q
first muscles to be paralyzed with neuromuscular blockade
A
facial muscles
22
Q
first muscles to recover after neuromuscular blockade and
A
diaphragm
23
Q
last muscles to be paralyzed after neuromuscular blockade
A
diaphragm
24
Q
components innate immunity
A
complement system
Natural alar cells
Phaco sites
Epithelial barriers
25
physiologic response to tumor necrosis factor What is the source
cachexia
source:
Macrophages, monocytes, T cells
26
physiologic response to IL1
fever related to hypo-thalamus
27
physiologic response to IL-2
promotes T-cell perforation and immunoglobulin production
28
physiologic response to IL-4
T-cell differentiation B cell activation
29
physiologic response to GM-CSF
admits granulocyte and monocyte production from bone marrow stem cells
30
urine output goals myoglobinuria
2 cc per kilogram per hour
31
adverse event
injury the results medical management and result in measurable disability
this includes preventable and preventable - given the current state of knowledge
32
near miss
could have resulted in injury/accident
it was prevented by chance or intervention
33
latent error
condition of the system is removed from the adverse event
Insidious and may not become evident and telemetry series of events have cascaded into perfect storm
poor design, incorrect installation, faulty maintenance, or inadequate staffing.
34
Side effect and treatment of isoflurane blue dye
anaphylaxis
subcutaneous epinephrine
35
mechanism of magnesium sulfate for premature labor
competitive inhibition of calcium influx
tocolytic
also used a seizure prophylaxis and patient's with preeclampsia
36
fibrolamellar hepatocellular carcinoma findings on imaging, labs, prognosis
more aggressive
Central fibrotic component-well-circumscribed
careful, focal nodular hyperplasia also has central scar
Neurotensin positive
AFP negative
37
and what type of shock is venous oxygen saturation increased
septic shock
38
where are pancreatic damage and activated
duodenum
39
enzymes are secreted in active form from pancreas
Amylase
Lipase
ribonuclease
deoxyribonuclease
40
A stone located in the common bile duct after cholecystectomy designated as recurrent at what time.
2 years after cholecystectomy
41
Maxillary torus
a symptomatic lesion of the hard palate
Benign osteoblastic tumor
Treatment only if symptomatic
42
Glioma ENT tumor
just lateral to nasal root-reddish firm noncompressible lobular lesions with cutaneous telangiectasia
43
Submucosa cleft palate
triad:
Bifid uvula
Notch at the junction of the hard palate and soft palate
zona pellucida - thin layer of mucosa in the midline the soft palate
44
workup pyloric stenosis
diagnosis can sometimes definitively be made with physical exam alone
Ultrasound:
Thickness 3-4 mm
Length 15-18 mm
45
pyloric stenosis presentation
male female-4:1
First born male
Hypochloremic hypokalemic metabolic alkalosis
46
Pyloric stenosis treatment
after resuscitation
potassium is not replaced until intravascular volume had been restored with normal urine output
Microscopic pyloromyotomy
47
Most important prognosis factor for 32-year-old female with well-differentiated papillary carcinoma
age!
Male under the age of 40 females under the age of 50
presence of metastases less important!
48
With the thyroid cancer prognostic is
AMES
age
Metastases
Extent of involvement
signs of tumor
49
spigelian hernia
BELOW arcuate line
Between semilunar line in the lateral edge of rectus
Covered via external oblique aponeurosis-difficult to palpate-CT scan
Surgery: Transverse abdominal incision over defect
All require operation
50
innervation of external anal sphincter
voluntary control
inferior rectal branch of the internal pudendal nerve
And
Peroneal branch of fourth sacral nerve
51
Innervation of the internal anal sphincter
Involuntary
Autonomic nervous system
52
half life of nutritional markers
albumin 21 days
Transferrin 8 days
prealbumin 1-2 days
53
treatment of patent ductus arteriosus
term infant 90-95% closed by 4 days
Preterm infant 80-90% closed by 30-37 weeks gestational age
Term infant Cox inhibitors ineffective
Premature infant Cox inhibitors effective
Asymptomatic PDA surgery between age 1-2:
VATS or transcatheter
symptomatic infant prompt closure
54
lab marker associated with active hepatitis B infection
HBsAg
hepatitis B surface antigen
+1-10 weeks after infection
disappears in for-6 months but present impairment 5 chronic infection
HBcAg
hepatitis B core antigen
intracellular antigen not in C-arm
Detectable orally after infection and persist after recovery and in chronic infections
55
laboratory markers associated with hepatitis B vaccination
Anti-HBs
anti-hepatitis B antibody
( but also appeared during window. After antigen disappears marked to recovery after hepatitis B infection)
56
most accurate diagnosis of hepatitis B infection
quantification of hepatitis B DNA in the serum
57
management of perforated appendicitis
percutaneous drainage and antibiotics if abscess or fluid collection demonstrated
this is not the treatment if there are peritoneal signs
58
antibiotic use for appendectomy of
single perioperative dose most commonly
59
when with broad-spectrum IV antibiotics and interval appendectomy in 6-12 weeks be reasonable
phlegmon present-this is not drainable collection and surgical intervention can be difficult acutely
some advocate early appendectomy in this population though
60
Clark's levels
```
level I epidermis
Level II papillary dermis
Level III junction between papillary and reticular dermis
Level IV reticular dermis
Level V subcutaneous fat
```
61
most common cause of renovascular hypertension
atherosclerosis
62
Pathophysiology of hypertension with renal artery stenosis
decreased pressure in affarent barroreceptors
stimulate juxtaglomerular apparatus
activated ring and angiotensin axis
63
pores of Kohn in alveoli
communication between alveoli
64
at what age to alveolar production began
some months gestation and continued until 10 years
65
lab findings associated with tree renal azotemia rather than an intrinsic cause of renal failure
urine sodium of less than 20 - this is consistent with the body trying to reabsorb sodium for water to follow.
FENa less than 1%
66
lifetime risk of postsplenectomy sepsis without immunos
1-5%
67
ovarian cancer staging
stage I-one or both ovaries only can be treated with resection alone
Stage II-extended involvement of tumor but limited to pelvis
Stage III-tumor involvement of the abdomen
Stage IV-distant metastases
68
mechanism of action of Finasteride
competitive inhibition of:
5a-Reductase
decreased serum and intra-prostate levels of dihydrotestosterone
helps relieve bladder obstruction
69
intraoperative parathormone assay
half-life 3-5 minutes
Within 10 minutes the excision:
50% drop of highest pre-excisional value indicates complete resection of hyperfunctional gland
70
Management if PTH does not drop to 50% and 10 minutes
Confirmed there is remaining hyperfunctioning tissue
Does not imply that gland removed was normal
71
treatment of undifferentiated spindle cell malignant fibrous histiocytoma of the bone
preop chemotherapy
Surgical resection
Most common site proximal tibia distal femur
72
treatment of infected pseudocyst
aspirated not draining by CT guidance or ultrasound
Gram stain and culture
If infection present, external drainage using surgical or percutaneous technique
73
cells responsible for contractile forces of the wound healing
myoepithelial cells
found in the basal layer of epithelium
74
most common cause of primary hyperparathyroidism
adenoma
hyperplasia is less common - though seen in MEN 1 and 2a
75
mechanism of dobutamine
only Beta adrenergic stimulation
using cardiogenic shock
low dose- beta one-contractility
high-dose-beta-2-vasodilation
76
Marjolin's ulcer
scar/burn squamous cell carcinoma
Majors have scars and burns
77
treatment of Marjolin's ulcer
surgical excision with 3-4 mm normal-appearing skin
Intraoperative frozen section
Surgery preferred and scarred or traumatized areas
Radiation is useful and high risk for recurrence after extensive surgical excision
Mohs procedure reserved for lesions with indistinct margins in areas where the important preserve skin
78
with cell releases tumor necrosis factor alpha
macrophages
principal mediator for gram-negative response
TNF also responsible for cachexia
79
femoral canal boundaries
superior-iliopubic tract
Inferior-Cooper's ligament
Medial-lacunar ligament
Lateral-femoral vein (careful, overall location of femoral veins medial compared artery)
80
first-order kinetic
elimination is directly proportional to blood concentration
most drugs follow this
81
zero order kinetic
elimination is independent of the concentration
seen with alcohol
82
SIADH physiologic findings
reabsorbing too much water
despite this, patient's remain overall normal volemic
sodium retention in the kidney needs to concentrated urine
83
what causes the periumbilical pain and acute appendicitis versus right lower quadrant pain pathophysiology of innervation
appendiceal luminal distention which activated visceral pain fibers causing the initial periumbilical pain
Peritoneal signs from inflammation her carried via somatic nerve fibers in the right lower quadrant
84
management of gallbladder adenoma
symptomatic adenomas are resected laparoscopically unless suspicious for malignancy
Asymptomatic adenomas not concerning for malignancy are followed q.6 months with ultrasound
Enlarging adenomas are resected
85
Suspicious for malignancy adenomas
greater than 1 cm
Greater than 3 in number
Sessile
Mucosal invasion on ultrasound
86
nerve involved with numbness in the foot drop - findings and common etiologies
common peroneal
Motor deficit often worse and sensory
supracondylar fracture
Proximal tibial fracture
Knee dislocation
87
gold standard test her insulinoma
72 hour fasting:
Him serum glucose and Ambien insulin concentration every 6 hours as collected and symptoms develop
Diagnoses is made if patient develops neural glycopenic symptoms and C-arm glucose is low her than 45 with CM insulin level higher than 5
C-peptide and Prolenes and confirm factitious causes
88
mechanism of urokinase
all thrombolyzes agents packed by converting Prolenes on plasminogen to plasma and
TPA recumbent
Converts plasminogen to plasmin
89
when is systemic thrombolysis used
acute myocardial infarction
Acute ischemic stroke
Massive pulmonary embolism
90
mechanism heparin
ACTIVATES antithrombin 3
This accelerated rate the anti-thrombin inhibitor enzymes of coagulation:
Thrombin
Factor X a
91
Organ of Zuckerkandl
most common site of pheochromocytomas
Anterior and lateral to distal abdominal aorta between takeoff of the inferior mesenteric artery and aortic bifurcation
92
treatment of 1 cm anal margin squamous cell carcinoma
excision
IS not Niagara protocol
93
treatment of recurrent squamous cell carcinoma of anal margin
possibly reexcision or APR
94
indications for nigro protocol
intra-anal lesion
Invasion of sphincter
possibly greater than 3 cm
5 fluorouracil
Mitomycin-C
3000 cGy
95
innervation of upper epiglottis
glossopharyngeal nerve
sensory pathway of gag reflex
96
innervation of lower epiglottis
recurrent laryngeal nerve
97
muscles innervated by recurrent laryngeal nerve
lower epiglottis
| All the muscles of the larynx except for the cricothyroid
98
type of innervation by superior recurrent laryngeal nerve
sensory! helps for feedback of pitch
99
Mycobacterium avium
aerobic non spore forming motile past bacilli
pulmonary disease with intact immune system
Disseminated disease with immunocompromise
100
Confirmation of disseminated Mycobacterium avium
culture positive:
Blood, bone marrow, liver, spleen
positive stool culture may just indicate carrier status
101
most common clinical presentation of Meckel's diverticulum in children
bleeding
102
name of hernia with Meckel's diverticulum and it
Littre's hernia
103
first step of workup for Stewart-Treves syndrome
incisional biopsy
104
treatment of Stewart-Treves syndrome
wide local excision with or without chemotherapy or radiation
105
what does the spinal accessory nerve innervated
sternocleidomastoid and trapezius
motor nerve only
106
where he fibers originate from first spinal accessory nerve
cranial root and medulla
cranial fibers exit jugular foramen
found in posterior triangle
107
normally distributed data
is perinephric
conforms to bell-shaped curved
108
Treatment of entamoeba the histolytica liver abscess
metronidazole
109
CT findings that differentiate entamoeba the histolytica liver abscess from pyogenic liver abscess
non-ring enhancing
110
mechanism of Mycophenolate Mofetil
CellCept
Purine synthesis inhibition
inhibits inosine monophosphate dehydrogenase and blocks the proliferation of lymphocytes.
111
major mechanism of corticosteroids and immunosuppression
inhibits cytokine gene transcription in macrophages
and inhibit cytokine secretion:
IL1
IL 6
TNF
suppress T cells
112
mechanism of cyclosporine
inhibit cytokine symphysis
IL-2 3 4
INF gamma
113
guidelines for intercranial pressure monitoring
post resuscitation GCS equal to or less than 8
and abnormal CT scan
Even with normal CT if:
H. greater than 40
History of hypotension
Abnormal motor posturing
consider inpatient with GCS of 12 or less who cannot be closely monitored clinically or CT scan demonstrates intracranial hypertension
114
Blood supply of the lungs
dual blood supply
Deoxygenated blood from pulmonary artery
oxygenated blood from bronchial arteries
2 left-sided bronchial arteries and one right sided bronchial artery (careful, even though 3 lobes on the right)
origin of bronchial arteries:
Thoracic aorta or arch but can join with intercostals
Some of venous return is via pulmonary veins
115
pulmonary sequestration
left more common for both
```
intralobar:
Within the lung parenchyma
mediastinum
posterior segments of the lower lobes
SYSTEMIC vessels from infradiaphragmatic aorta
found in inferior pulmonary ligament
Venous drainage through inferior pulmonary vein but can be systemic veins
workup: CT MRI more common than angio
treatment: Segmentectomy or lobectomy
```
Extralobar:
Surrounded by separate pleural covering
more common extrapulmonary anomalies
116
normal resting lower esophageal sphincter pressure
10–20
117
Lower esophageal sphincter pressure during swallow
zero
118
Normal resting upper esophageal sphincter pressure
50-70
119
most common cause a splenic vein thrombosis
chronic pancreatitis
pseudocyst can also cause this
120
neck step in management with palpable neck mass calcium of 15 elevated PTH
NO FNA
En bloc total parathyroidectomy with ipsilateral thyroidectomy
121
management of delayed presentation of femoral artery trauma
in almost always be managed with direct repair.
122
management of popliteal artery trauma
Popliteal artery injury usually require interposition grafting
123
Management of isolated tibial vessel injury
No treatment needed as long as one out of 3 vessels patent
124
Neonatal and prenatal testicle torsion
extravaginal-testicle and both layers of the tunica vaginalis rotate
May not produce symptoms the testicle was atrophied and salvage is rare
125
testicular torsion and young adults and children
interventional-testicle and inner layer of tunica vaginalis rotate
Clinical diagnosis-no ultrasound needed
126
Review most somatostatin neuromas originate
periampullary and ampullary region most common site
proximal pancreas
or pancreaticoduodenal groove
127
Cloot triangle
common HEPATIC duct
Cystic duct
Free edge of the liver
Contains colon
Cystic artery
128
was common site for VIP Oma
body and tail
129
Most common site for glucagonoma
body and tail
130
Treatment for squamous cell carcinoma of the volva
less than 1 mm depth wide local excision
Greater than 1 mm depth:
Radical vulvectomy extends to endopelvic fascia
2 cm margin
Bilateral inguinal node dissection
If the lesion is ipsilateral ipsilateral inguinal node dissection
Positive nodes or extension into vagina or anus requires adjuvant chemotherapy and radiation therapy
131
with at what level does the innominate artery across the trachea
fifth tracheal ring
